Designer drug deaths prompt urgent call

Coroner issues recommendations for drug checking and early warning systems after five young men died from ingesting dangerous psychoactive substances

A Victorian coroner has recommended that the state government implement a drug checking service and a drug early warning network following a spate of accidental deaths.

Five men aged between 17 and 32 died in Melbourne between July 2016 and January 2017, as a direct or indirect result of ingesting a dangerous combination of two novel psychoactive substances.

The drugs were generally being marketed around the city in tablet form as MDMA but were actually comprised of 25C-NBOMe and 4-Fluoroamphetamine.

25C-NBOMe10 is a designer novel psychoactive substance available in powder form, pills or as blotter paper.

Anecdotal reports indicate that 25C-NBOMe is highly potent, with potential complications including hyperthermia, seizures, metabolic acidosis, rhabdomyolysis, organ failure and death.

The NPS 4-Fluoroamphetamine (4-FA) is a psychomotor stimulant that has been found in products sold as ecstasy and amphetamine powders, as well as an adulterant in other illicit substances.

It is most often consumed orally or via nasal inhalation.

Studies have shown that severe toxic effects include severe cardiovascular and cerebrovascular complications including intracerebral haemorrhage.

Most of the men manifested extreme behaviours after ingesting the drugs.

In four cases, the men passed away from accidental overdose, in circumstances of mixed drug toxicity with involvement of 25C-NBOMe and 4-FA. A fifth man died from injuries sustained in fall from height after using the drugs.

Dr Monica Barratt, a Senior Research Fellow at the Royal Melbourne Institute of Technology (RMIT), noted that in all five cases, the people who died did not know they were consuming those novel psychoactive substances. Instead they believed they were consuming MDMA or, in one case, psilocybin.

“If the deceased had known their drugs contained 4-FA combined with 25C-NBOMe rather than MDMA, they may have decided not to take the drug at all, or they may have taken it anyway but via a different route of administration,” she said.

Dr Barratt told the inquest that a consumer-facing drug checking service is needed, where people can submit substance samples for rapid analysis of content and purity.

She also argued that a Victorian drug early warning network or system is needed, bringing together the broadest possible range of information sources (including drug checking service analysis) and stakeholders to identify and respond to issues in unregulated drug markets.

At present drug checking services are not permitted to operate in Victoria, and there is no integrated drug early warning network. However drug checking services have been implemented successfully elsewhere in Australia.

Coroner Paresa Antoniadis Spanos recommended the Victorian Department of Health implement a drug checking service and a drug early warning network in the State of Victoria “as a matter of urgency”, to reduce the number of preventable deaths and other lesser harms associated with the use of drugs obtained from unregulated drug markets.

She noted that risk has always existed when obtaining drugs from unregulated markets, and this risk is heightened through the proliferation of novel psychoactive substances.

“If we accept that there are unlikely to be any major changes to drug regulation in the foreseeable future, or any changes in individual’s preparedness to use illicit drugs, Victorians will continue to be exposed to the risks of unregulated drug markets,” said Coroner Spanos.

“The evidence available to me supports a finding that there is broad support for a drug checking service and drug early warning network as evidence-based interventions, at least among those with knowledge and expertise in harm minimisation.”

However Professor Euan Wallace from the Victorian Department of Health and Human Services (DHHS) told the coroner the government has no current plans to trial pill testing at public events.

“The department is considering opportunities to better monitor and respond to alcohol and drug consumption, harm and risk in a more systematic and timely manner,” said Professor Wallace.

“This includes timely identification of harms through analysis of existing health and justice data and other testing sources. The Victorian Government has no current plans to trial pill testing at public events.”

A submission on behalf of the Victoria Police Chief Commissioner clearly articulated an opposition to drug-checking, stating that “lawful drug checking could imply that drug use is condoned by the State Government and that there are circumstances in which consuming illicit drugs is safe.”

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